But most proposed federal attempts at malpractice reform would either be unworkable or would infringe on individual states' prerogatives to reform their systems.Former senator Bill Bradley has suggested the government establish medical courts, similar to bankruptcy or admiralty courts that employ special judges. Others have suggested impartial physician panels to adjudicate claims. These proposals are superficially attractive but unfeasible. Bankruptcy and admiralty law involve legal issues judges understand. Malpractice issues are primarily medical, requiring jurists with extensive -- and expensive -- medical training. Nor would panels of impartial physicians work. Physicians, though well versed in matters medical, are no more impartial than any other professionals. No profession should decide its own disputes with the public.

Tort reform does address one undeniable consequence of malpractice: the high cost of malpractice insurance. In plaintiff-friendly venues, specialists paying exorbitant insurance rates may move elsewhere, leaving an area without specialists. Federal reform definitely could have an impact, either by limiting pain and suffering (non-economic) damages, or by limiting attorneys' fees, thereby discouraging many lawsuits. But is this the federal government's role? Access to specialists and exorbitant malpractice rates are primarily local problems, not national concerns. States should decide when and how to curb non-economic damages or restrict attorneys' fees to relevel the playing field in a given locale. Federal micromanagement would remove this power from the states.

Cory Franklin is a consultant on medical malpractice and the former director of intensive care at Cook County Hospital.